How many episodes of Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT) require lifetime anticoagulation with Eliquis (Apixaban)?

From the Guidelines

Patients with recurrent VTE events (at least two episodes) are typically recommended for indefinite anticoagulation therapy with Eliquis (apixaban). The decision to extend anticoagulation is based on the assessment of the risk of recurrent thrombosis versus the risk of anticoagulant-related bleeding 1. According to the 2019 ESC guidelines, oral anticoagulant treatment of indefinite duration is recommended for patients presenting with recurrent VTE (that is, with at least one previous episode of PE or DVT) not related to a major transient or reversible risk factor 1.

Key Considerations

• The number of episodes of PE or DVT that requires lifetime anticoagulation is not strictly defined, but rather depends on the presence of recurrent events and other clinical factors.
• Patients with a single unprovoked PE or DVT who have high-risk features may also be candidates for lifelong anticoagulation.
• The standard maintenance dose of Eliquis for indefinite therapy is 5 mg taken orally twice daily, but a reduced dose of 2.5 mg twice daily may be considered after 6 months of therapeutic anticoagulation 1.
• Regular follow-up with a healthcare provider is essential to periodically reassess the risk-benefit ratio of continued anticoagulation, monitor for complications, and ensure appropriate dosing based on age, weight, and kidney function.

Clinical Context

The recommendation for indefinite anticoagulation is based on the understanding that patients with recurrent VTE events have demonstrated a persistent tendency toward clot formation, and the risk of recurrent thrombosis without anticoagulation outweighs the bleeding risks associated with continued therapy 1. However, the decision to extend anticoagulation should be individualized and take into account the patient's specific clinical circumstances, including their bleeding risk and other comorbidities.

From the Research

Episodes of Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT) Requiring Lifetime Anticoagulation with Eliquis (Apixaban)

• The decision to extend anticoagulation with apixaban is based on individual patient risk factors, including the risk of recurrent VTE and the risk of anticoagulant-related bleeding 2, 3, 4.
• Current guidelines recommend anticoagulation for a minimum of three months, with extended anticoagulation considered for patients with a high risk of recurrence and a low risk of bleeding 3, 4.
• The use of apixaban for extended anticoagulation has been shown to reduce the risk of recurrent VTE without increasing the risk of major bleeding 5, 6.
• Specific patient groups, such as those with cancer or pregnancy, may require special consideration when determining the duration of anticoagulation 2, 4.
• The decision to use lifetime anticoagulation with apixaban should be individualized based on a risk-benefit analysis, taking into account the patient's risk factors and medical history 3, 4, 6.

Factors Influencing the Decision for Lifetime Anticoagulation

• Risk of recurrent VTE: Patients with a high risk of recurrence may benefit from extended anticoagulation 3, 4, 5.
• Risk of anticoagulant-related bleeding: Patients with a high risk of bleeding may not be candidates for extended anticoagulation 3, 4, 5.
• Patient-related factors: Such as age, comorbidities, and renal function, may influence the decision to extend anticoagulation 2, 4.
• Specific patient groups: Such as those with cancer or pregnancy, may require special consideration when determining the duration of anticoagulation 2, 4.